| NPI | 1700357480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.163017) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH S.2511824) |
| Enumeration Date | 2018-12-06 |
| Last Update Date | 2026-06-08 |